Provider Demographics
NPI:1821255191
Name:MICHAEL D. RIORDAN, D.M.D., P.C.
Entity Type:Organization
Organization Name:MICHAEL D. RIORDAN, D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:RIORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:803-802-2580
Mailing Address - Street 1:1741 GOLD HILL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-8202
Mailing Address - Country:US
Mailing Address - Phone:803-802-2580
Mailing Address - Fax:803-802-3075
Practice Address - Street 1:1741 GOLD HILL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-8202
Practice Address - Country:US
Practice Address - Phone:803-802-2580
Practice Address - Fax:803-802-3075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC25540552261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental